Background

The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic.

Methods

All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasaki- like presentations were managed as Kawasaki disease according to the American Heart Association indications. Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively.

Findings

Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment (three of 19 vs eight of ten; all p<0·01).

Interpretation

In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic.

Funding

None.

中文翻译：

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在SARS-CoV-2流行病的意大利震中爆发严重的川崎样疾病：一项观察性队列研究。

背景

贝加莫省受到严重急性呼吸系统综合症冠状病毒2（SARS-CoV-2）流行的广泛影响，是普通人群中病毒表现的自然观测站。在过去的一个月中，我们记录了川崎病的爆发；我们旨在评估在SARS-CoV-2流行期间诊断出的川崎样疾病患者的发病率和特征。

方法

根据SARS-CoV-2流行病开始之前（第1组）或之后（第2组）的症状表现，对过去5年来在我们中心被诊断为川崎样疾病的所有患者进行了分类。根据美国心脏协会的指示，将川崎样病表现作为川崎病治疗。川崎病休克综合征（KDSS）由循环功能障碍的存在定义，巨噬细胞活化综合征（MAS）由小儿风湿病国际试验组织标准定义。通过鼻咽拭子和口咽拭子中的逆转录酶定量PCR以及通过分别检测SARS-CoV-2 IgM和IgG的血清学定性检测来寻找当前或先前的感染。

发现

第一组包括2015年1月1日至2020年2月17日之间确诊的19名患者（七名男孩，十二名女孩；年龄3·0岁[SD 2·5]）。第二组包括十名患者（七名男孩，三名女孩；年龄） 2020年2月18日至4月20日诊断为7·5年[SD 3·5]；十分之八的IgG或IgM或两者均为阳性。两组在疾病发生率（第1组vs第2组，0·3 vs每月10个），平均年龄（3·0 vs 7·5岁），心脏受累（19个中的两个vs十个中的六个）方面有所不同。的19零VS 10的5个），MAS（19零VS 10的5个），并需要辅助类固醇治疗（三个19 VS 8 10的;所有的p <0·01）。

解释

在过去的一个月中，我们发现类似川崎病的发病率增加了30倍。SARS-CoV-2流行开始后被诊断出的儿童显示出对该病毒的免疫反应的证据，年龄较大，心脏受累率较高，并且具有MAS特征。SARS-CoV-2流行与严重形式的川崎病高发有关。预计在SARS-CoV-2流行国家中也会发生类似的川崎样疾病暴发。

资金

没有。